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Emdeon Referral Tutorial
May 28, 2014
Confidential and Proprietary. Not for reproduction or distribution.
• Page 2
Healthfirst Leaf Plan members will require referrals from their PCPs to
visit a Leaf Plan participating specialist.
Referrals are not required for the following care:
• Primary Care
• Emergency Services
• OB/GYN Visits
• Urgent Care
• Outpatient Mental Health and Substance Abuse
Healthfirst has partnered with Emdeon to coordinate referral requests
for our Leaf Plan members. Leaf Plan providers can access Emdeon
through the Healthfirst secure Provider Portal.
Overview
Confidential and Proprietary. Not for reproduction or distribution.
• Page 3
As a Healthfirst Leaf Plan provider, you may access the Emdeon
Referral Request System one of three ways:
1. On the HF Provider Portal homepage, click on the Authorizations/Referrals link under
the Tools section on the right side of the page.
After clicking on the hyperlink, you will be directed to a tab where you can Create a
New Referral and be directed to the Emdeon log in page.
If you are a Specialist, you may also Search for a referral by typing in the
Referral/Trace number or by entering in the member’s information.
Access to Emdeon
Confidential and Proprietary. Not for reproduction or distribution.
• Page 4
2. On the HF Provider Portal homepage, scroll over the header link Provider
Inquiries and select Referrals from the drop down menu.
You will then be directed to the landing page below announcing the
partnership between Healthfirst and Emdeon to handle Referral requests.
Click on the link indicated below to be re-directed to the Emdeon website
for your Referral inquiry.
Access to Emdeon
Confidential and Proprietary. Not for reproduction or distribution.
• Page 5
3. Type in the following URL in the address line of your browser:
• https://office.emdeon.com/vendorfiles/healthfirst.html
• This will give you direct access to the Emdeon Login page.
Access to Emdeon
Confidential and Proprietary. Not for reproduction or distribution.
• Page 6
At the Log In Screen:
1. Enter your User ID and
Password.
2. Click Log In.
3. You will be directed to the
Home Page.
4. If you do not yet have a User ID, click on Enroll New
User and complete the Pre-Registration process.
Getting Started
Confidential and Proprietary. Not for reproduction or distribution.
• Page 7
Password & Recovery
• To recover or reset your password, click on “I Forgot My Password”
• Answer the two security questions, enter your Tax ID and Zip Code
in the appropriate fields, and click Submit.
• If you select the a pop-up will appear with the Emdeon Support
phone number to call for assistance.
Password Reset & Recovery
Submitting Referrals for
Healthfirst Leaf Plan Members
Confidential and Proprietary. Not for reproduction or distribution.
• Page 9
Overview
The New Service Review provides a way to refer patients online.
The New Service Review form is used to send all the pertinent patient
and service information to the payer in the form of a referral request.
Benefits
• Electronic referral requests
• Eliminate time-consuming paper and phone-based processes
• Comply with Managed Care requirements
Referrals – Service Reviews
Confidential and Proprietary. Not for reproduction or distribution.
• Page 10
Submit a New Referral
New Service Review
Confidential and Proprietary. Not for reproduction or distribution.
• Page 11
Gather your Healthfirst identification information:
• Patient’s Healthfirst Leaf Plan Member ID number
• Your Healthfirst Provider ID number
• The Healthfirst Provider ID number of the specialist you are referring the
member to.
1. Select Service Review > New Review from the main menu at the top of the
homepage screen.
2. Select a Plan should already be populated with Healthfirst New York however
if it is not please select it.
3. The type of service review should already be populated, however if it is not,
please select New Specialty Care Review
4. Enter Subscriber ID and Provider information of your new review:
• Enter the Healthfirst Leaf Plan Subscriber ID
• Under Requesting Provider the Payer Assigned ID should already be
populated; Enter your active Healthfirst Provider ID
• Under Service Provider, please select Payer Assigned ID and enter the
specialist Healthfirst Provider ID.
Submit a New Referral
Creating a New Service Review
Confidential and Proprietary. Not for reproduction or distribution.
• Page 12
5. If you need to verify/confirm the Healthfirst Provider ID for the specialist you are
referring to, please click on the Provider Directory link on the upper right hand
side of the screen.
• Alternatively, you can also access the Healthfirst online provider directory
through hfdocfinder.org
6. Select a Service Type. This field will default to Physician Visit – Office: Sick,
however it can be changed as appropriate.
7. Enter in the number of Visits. Please note that the maximum number of visits is
6 visits in a 6 month period.
8. The Start Date and End Date will already be populated with a 180 day period.
9. Enter Diagnosis Code. Clicking Edit will allow you to search for diagnosis
codes using key words or code values.
10.Click Send to Payer to submit the new service review.
Next a response appears.
Submit a New Referral
New Service Review
Confidential and Proprietary. Not for reproduction or distribution.
• Page 13
Make a note of the Emdeon trace number. Healthfirst will want you to use this
when checking the status of your service review.
11.An Approved referral will list “Certified in Total”
12.Click on Save Response to Batch. You can save the referral you just
requested by clicking on save. It will save to a default folder that you will be
able to view.
13.You may print the approved referral by clicking the Print icon in the top right
corner of the screen.
Submit a New Referral
New Service Review
Emdeon Batch Manager
for Referrals
Confidential and Proprietary. Not for reproduction or distribution.
• Page 15
Overview
All referral transactions submitted and saved under the “Default” batch name
by your practice can be accessed through the Batch Manager function.
1. Select Batch Manager from the main menu.
2. The Manage Batches screen appears.
Emdeon Batch Manager
for Referrals
Confidential and Proprietary. Not for reproduction or distribution.
• Page 16
3. Select the batch you wish to view by clicking on “Default”. Details from the
selected batch will display in the Batch Inquiry screen, as shown below.
Emdeon Batch Manager
for Referrals
Confidential and Proprietary. Not for reproduction or distribution.
• Page 17
Clicking on any column header on the Batch Inquiry screen will cause
the batch list table to be resorted based on the selected column.
• A yellow triangle is displayed in the column header to indicate which
field is the current sort criterion.
• An upwards pointing triangle means the search is in ascending or
alphabetical order.
• Clicking on a column which is already being used as the sort criteria
will cause the sort order to reverse and the triangle to turn upside
down.
• To search for a specific referral, you may enter the Subscriber ID in
the search filed.
Sort Referral Transactions
Confidential and Proprietary. Not for reproduction or distribution.
• Page 18
Search Within a List Referrals
To search within a batch, select the batch by clicking on it.
• When the Batch Inquiry screen displays, enter the data in the
Search Text field to narrow down the number of referral
transactions.
• After clicking the Search button, only those transactions that match
the data in the Search Text field will display as shown in the image
below.
• You can search the “Default” batch for member specific referrals by
using a Healthfirst Member ID in the Search Text field.
• This will produce the a list of referral transactions submitted for that
specific Healthfirst Leaf Plan member
Confidential and Proprietary. Not for reproduction or distribution.
• Page 19
Search Within a List Referrals
The Clear button (next to the Search button) can be used to remove
the search filter and show all referral requests in the batch. Clicking the
Search button also clears the search filter if no value is entered in the
Search Text field.
Confidential and Proprietary. Not for reproduction or distribution.
• Page 20
Don’t Forget!
• Check Leaf Plan Member Eligibility on the Healthfirst Provider Portal
• Confirm Leaf Plan member is assigned to your panel
• Check Provider Leaf Plan Participation Status to ensure the
specialist provider you are referring to is an in-network provider on
www.hfdocfinder.org
• Confirm the Healthfirst Provider ID for the provider you will be
referring the Leaf Plan member to. You will need this provider ID
number to finalize the Emdeon referral transaction.
*Please note: There is no out-of-network coverage for Leaf Plan
members with the exception of emergency care.
Confidential and Proprietary. Not for reproduction or distribution.
• Page 21
THANK YOU